Toxicology and Antidotes Flashcards
(51 cards)
What is toxicology?
The study of adverse effects of chemical exposures
Most common victims of accidental poisoning in the US
Children
Drugs that are excluded from child-resistant packaging
Nitroglycerin SL tabs
Topical exposure counseling
Remove contaminated clothing and wash skin with soap and water for 15 min
Ocular exposure counseling
Remove contacts and rinse eyes with a gentle stream of water for 15 min
PO exposure counseling
Remove substance from mouth drink small glass of water or milk
Ingestion of button batteries
2 tsp of honey Q10M with immediate medical attention
Steps of BLS
Circulation, airway, breathing:
1. Pulseless: give 2 breaths for every 30 chest compressions
Why do you use charcoal for decontamination
Absorbs drug preventing systemic and GI absorption
Dosing of charcoal
Used within 1 hr of ingestion
Dose: 1 g/kg
What do you need to do prior to charcoal?
- Make sure airway is protected to prevent aspiration
What compound can ↑ the risk of aspirations?
Hydrocarbon
CI of charcoal?
- Airway is unprotected
- Intestinal obstruction
- GI is not inteact
Max APAP
<4g
Mechanism of APAP Hepatotoxcity
Dose-dependent: ↑ metabolism of APAP by CYP2E1 to NAPQI → bind to liver cells → liver failure
Describe the phases of APAP toxicity
Phase 1: (1-24hr) asymptomatic, nausea, vomiting
Phase 2: (24-72hr) Elevated INR, AST/ALT
Phase 3: (72-96 hr) Fulminant hepatic failure, jaundice, coagulopathy, renal failure, death
Phase 4: (>96 hr) the patient recovers or receives a liver transplant
Antidote for APAP?
NAC (given within 8 hr)
How do you determine the amount of NAC?
Rumack-Matthew nomagram
MOA of NAC
Free radical scavenger and precursor to glutathione → ↑ GSH → converts NAPQI to non-toxic metabolites
Admin of PO or IV NAC
PO: high dose given once, then lower doses x 17. Repeat if emesis occurs within 1 hr of admin
IV: 3 infusions over 21 hrs
Sx of anticholinergic OD? AD?
Flushing, dry skin, mydriasis, blurry vision
Physostigmine and supportive care
Sx of anticholinergic OD?
Bleeding
AD of factor xa inhibitors
Andexanet alfa (Andexxa)
AD of dabigatran
Idarucizumab (Praxbind)
